A Case of Intramuscular Lipoma of Thenar Eminence With a Short Review of Published Hand Lipoma Case Reports.

Lipoma is a common soft tissue tumour in the human body, but at the same time is very rare in the palm and rarer still in the thenar region. These lipomas in the hand can give rise to various problems such as cosmetic, functional, and neurological compromise among others and removing them becomes important when symptomatic. Diagnosing a hand pathology becomes important as a missed diagnosis can have long-term functional consequences for a patient. In the case report, we discuss a hand palmar prominence which presented as an effusion and later turned out to be a large lipoma. Further, we also present a literature review of published thenar lipoma cases to throw light on the nuances of this rare pathology location, which, to our knowledge, has not been done comprehensively.

Risk factors predicting early in-hospital mortality among underfive children and need for decentralization of pediatric emergency care services.

Background: Lack of pediatric triage and emergency care system in peripheral healthcare centers leads to unnecessary referral of low- and medium-risk patients. This study was conducted to study the risk factors predicting mortality within 48 h of admission in neonates and under-five children referred to the pediatric emergency of a tertiary care hospital in India. Methods: This prospective study was conducted on children (0-5 years) referred to the pediatric emergency who were enrolled and followed up. The outcome was defined as "survival" or "death" at 48 hours. Logistic regression analysis was conducted to assess the predictors of early in-hospital mortality. Results: A total of 246 consecutive pediatric (62 neonates, 52 young infants, and 132 children aged 1-5 years) referral cases were enrolled; mortality within 48 hours was 20%. Lack of pediatric intensive care (odds ratio [OR] 4.07, 95% confidence interval [CI] 2.0, 8.32, P = 0.02), lack of neonatal intensive care (OR 2.10, 95% CI 1.01,4.28, P ≤ 0.001), distance from referral center >20 km (OR 4.61, 95% CI 2.01, 10.58, P = 0.0003), >1 h taken during transport (OR 7.75, 95% CI 2.93, 20.46, P < 0.001), lack of ambulance facility (OR 0.04, 95% CI 0.009, 0.143, P < 0.0001), very sick condition on arrival (OR 210.1, 95% CI 12.1, 3643.41, P = 0.0002), and unstable temperature-oxygenation-perfusion-sugar on arrival were the independent risk factors predicting in early in-hospital mortality. Conclusion: Developing a pediatric triage and monitoring system, tele-pediatric intensive care unit, regionalizing referral-back-referral services with robust interhospital communication, and strengthening pediatric emergency services are the need of the hour to reduce early in-hospital mortality.

Production of Recombinant Active Human TGFß1 in Nicotiana benthamiana.

The production of recombinant proteins in plant systems is receiving wider attention. Indeed, various plant-produced pharmaceuticals have been shown to be biologically active. However, the production of human growth factors and cytokines in heterologous systems is still challenging because they often act as complex forms, such as homo- or hetero-dimers, and their production is tightly regulated in vivo. In this study, we demonstrated that the mature form of human TGFß1 produced and purified from Nicotiana benthamiana shows biological activity in animal cells. To produce the mature form of TGFß1, various recombinant genes containing the mature form of TGFß1 were generated and produced in N. benthamiana. Of these, a recombinant construct, BiP:M:CBM3:LAP[C33S]:EK:TGFß1, was expressed at a high level in N. benthamiana. Recombinant proteins were one-step purified using cellulose-binding module 3 (CBM3) as an affinity tag and microcrystalline cellulose (MCC) beads as a matrix. The TGFß1 recombinant protein bound on MCC beads was proteolytically processed with enterokinase to separate mature TGFß1. The mature TGFß1 still associated with Latency Associated Protein, [LAP(C33S)] that had been immobilized on MCC beads was released by HCl treatment. Purified TGFß1 activated TGFß1-mediated signaling in the A549 cell line, thereby inducing phosphorylation of SMAD-2, the expression of ZEB-2 and SNAIL1, and the formation of a filopodia-like structure. Based on these results, we propose that active mature TGFß1, one of the most challenging growth factors to produce in heterologous systems, can be produced from plants at a high degree of purity via a few steps.

Thigh Abscess as an Uncommon Complication of Left-Sided Colonic Diverticulitis and the Pitfalls in Treatment: An Interesting Case Report.

Colonic diverticulitis is one of the common causes of surgical intervention in general surgical practice. In most cases, surgical intervention depends on the presence of a collection around the sigmoid colon, the feasibility of percutaneous drainage, and the patient's medical condition. The collection can occur in the thigh in rare cases due to a fistulous communication with the retroperitoneum and can track gravitationally along the psoas muscle into the thigh and leg without any discernible collection around the sigmoid colon or in the abdominal cavity. We came across a similar case of a 54-year-old man who presented with abdominal pain, and thigh and leg swelling. Left-sided colonic diverticulitis was seen without any discernible abdominal collection and a thigh abscess during the initial clinical presentation. He was treated with multiple drainages of the thigh abscess, ultimately followed by a Hartmann's procedure over a total hospital admission period of 52 days. Current literature does not throw much light on such a situation and makes it all the more critical to illustrate this case. We present this rare case and give a complete account of investigations, disease course, and the interventions done to throw light on the optimal management of such cases.

Dynamic Hip Screw Plate Length in Stable Intertrochanteric Fracture Neck of Femur: A Systematic Review.

There has always been a debate between the use of four and two-hole plate for the fixation of stable intertrochanteric fractures. The choice is usually influenced by the general practice of the particular institution and the surgeon's preference. While the dynamic hip screw (DHS) is the implant of choice for stable intertrochanteric fractures of the femur, the length of the side plate to be chosen for optimal results has no clear consensus and previous studies regarding the same have been inconclusive. In our systematic review, we aimed to review the evidence available on the selection of the optimal length of the side plate and bridge the glaring gap that exists in the literature. Our systematic review included a thorough search of databases like PubMed, Embase, MEDLINE, CINAHL, and the Cochrane Library, using the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included both clinical and biomechanical studies satisfying our search criteria on two- and four-hole DHS implants. A total of 4556 results were obtained from the above databases, sorting out led to final 15 studies on the topic. It was found that the two-hole DHS implant was inferior in terms of lab-controlled biomechanical properties, while only having a slight advantage in terms of real-life postoperative blood transfusions and operative time. At the same time, the two-hole plate was similar to the four-hole plate in other clinical parameters. In this study, the two-hole plate while appearing promising in a few areas did fall short in other aspects like biomechanical studies, and the use should be reserved for cases where a four-hole plate cannot be used until further randomised control trials are carried out.

Residual deformity versus recurrence following Dupuytren's palmar fasciectomy-a long term follow-up of 142 cases.

INTRODUCTION: and background: Surgical options for Dupuytren's disease (DD) are multiple, and Dupuytren's palmar fasciectomy (PF) is a common surgical procedure performed for contractures that cause functional and cosmetic disability. The recurrence rate for PF has been reported to be very variable, ranging from 12 to 73%, according to various studies. One of the reasons for the varied range is the inconsistency in the method followed to define recurrence. Subsequently, a consensus-based definition was formulated in 2016, and we analysed the outcome in our series of patients treated with PF based on this standard definition. We also analysed the residual deformity associated in these cases. METHOD: ology: Our study is a retrospective analysis of 142 consecutive cases of primary Dupuytren's palmar fasciectomy by a single surgeon in three different centres. We followed the international consensus definition for analysing recurrence in these cases, and we also analysed residual cases as a separate entity. RESULTS: The mean age of the cases was 67.13 years and the mean follow-up period was 3.95 years. Alcoholism, smoking, diabetes and hypercholesterolemia were the commonest associated risk factors. The commonest affected finger and the finger with the maximum deformity were the little finger. The overall rate of recurrence of deformity was 3.5% and the rate of residual deformity was 30.3%. The overall complication rate was 11.9%. CONCLUSION: Recurrence and residual deformity can be considered as separate entities. The term 'residual deformity' can be used to denote patients with persisting deformity or those who incur deformity within one year of the primary surgery.